A National Obesity-Prevention Program Developed …...Source: National Center for Health Statistics Among children and teens ages 6-19, 17.1 percent are overweight according to the

1

U.S. Department of Health and Human

Services

National Institutes of Health

National Heart, Lung, and Blood Institute

National Institute of Diabetes and Digestive and Kidney Diseases

National Institute of Child Health and Human Development

A National Obesity-Prevention Program Developed by the National Institutes of Health

YourLogo Here

National Cancer Institute

Presenter

Presentation Notes

Welcome. We’re delighted to speak with you today about We Can! – a new program that we are very excited about and thrilled to have been chosen to participate in. We Can! is a national obesity-prevention program developed by the National Institutes of Health.

2

Flexible! Variety of

settings

A national education program targeting youth, ages 8–13, and their parents and caregivers in

home and community settings to meet the overall goal of preventing overweight and obesity.

Turn key! Science-based

program for the entire community

Fosters collaboration!

Presenter

Presentation Notes

We Can! is a national education program targeting youth, ages 8-13, and their parents and caregivers in home and community settings to meet the overall goal of preventing overweight and obesity.

3

A National Collaboration We Can! is a collaborative effort of four

Institutes within the National Institutes of Health (NIH): National Heart, Lung, and Blood Institute

(NHLBI) National Institute of Diabetes and Digestive

and Kidney Diseases (NIDDK) National Institute of Child Health and Human

Development (NICHD) National Cancer Institute (NCI)

Presenter

Presentation Notes

We Can! is a collaborative effort of four Institutes within the National Institutes of Health. These institutes are the: National Heart, Lung, and Blood Institute (NHLBI); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Institute of Child Health and Human Development (NICHD); and National Cancer Institute (NCI).

4

Why We Can!

National trends and statistics show alarming changes in: Overweight and obesity rates Calorie intake Food and beverage consumption Television viewing

Presenter

Presentation Notes

Why We Can!? National trends show alarming changes in overweight and obesity rates, calorie intake, food/beverage consumption and television viewing. Some startling statistics: In the U.S., nearly one-third of all adults are classified as obese – a figure that has more than doubled over the last 30 years. Perhaps even more alarming is the staggering impact the epidemic of overweight and obesity has had on children. In just 30 years, obesity has more than doubled among children ages 2-5 and adolescents ages 12-19, and more than tripled among youth ages 6-11. This phenomenon has directly contributed to outcomes such as the dramatic incidence of type 2 diabetes in children. This illness was once considered nonexistent in adolescents. It is now estimated to account for up to 45% of newly diagnosed diabetes cases in children and adolescents.

5

Percentage of U.S. Children and Adolescents Who Are Overweight*

4 4

7

16

1917

5

17 17.6

15

11

5

17

6

02468

101214161820

1963-65;1966-70

1971-1974

1976-1980

1988-1994

1999-2000

2001-2002

2003-2004

2003-2006

Ages 6-11

Ages 12-19

* >95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts**Data are from 1963-65 for children 6-11 years of age and from 1966-70 for adolescents 12-17 years of ageSource: National Center for Health Statistics

Presenter

Presentation Notes

Among children and teens ages 6-19, 17.1 percent are overweight according to the 2003-2004 NHANES data (source below). This represents a 55 percent increase from the overweight estimates of 11 percent obtained from 1988-94. Race/Ethnicity “The prevalence of overweight in Mexican American male children and adolescents was significantly greater than non-Hispanic white male children and adolescents” There was no difference between non-Hispanic while male children and adolescents and non-Hispanic black males children and adolescents. Mexican American and non-Hispanic black female children and adolescents were significantly more likely to be overweight compared with non-Hispanic white female children. Between Sexes “ Among children and adolescents ages 2 to 19 years in 2003-004, no significant difference in prevalence of overweight was found between the sexes.” Source: JAMA, April 5, 2006, Vol. 295, No. 13:1549 “Tests of trend using logistic regress adjusted for age and race/ethnicity showed a significant increase in the prevalence of overweight children in adolescents over 1999-2000, 2001-2002, and 2003-2004 (p = .0396 for males and p = .0463 for females).” Rounded to whole numbers on graph 1999-2000, 15.1 and 14.8 percent for 6-11- and 12-19- year-olds, respectively. 2001-2002, 16.3 and 16.7 percent for 6-11- and 12-19- year-olds, respectively. 2003-2004, 18.8 and 17.4 percent for 6-11 and 12-19- year-olds, respectively.

6

Trends in Overweight* for Children (2-19 Yrs)

0

5

10

15

20

25

1999-2000 2001-2002 2003-2004 2003-2006

All (2-19 Yrs) Non-Hispanic White Non- Hispanic Black Mexican American *BMI≥95th percentile of BMI-for-age, 2000 CDC growth chartsSource: NHANES 1999-2004 Ogden et al. JAMA 2006.

%

Presenter

Presentation Notes

We all know the increasing trend in overweight among US children. Between 1980 and now, the prevalence of overweight in children and adolescents has tripled. Latest NHANES analysis 2004 in a JAMA paper released 4/5/06 show 16.3% of children and teens ages 2-19, currently overweight: A significant increase from 14% just 4 years earlier 15.6% of children are at risk for overweight or overweight Certain ethnic groups are at even greater risk, including Hispanic, African American, and Native Americans. Race/ethnic groups also show differences in prevalence rates, with the highest rates in both African Americans and Mexican Americans

7

Why the Increase? Multiple causes

Lifestyle, environment, and genes

Bottom line = ENERGY BALANCE (calories and physical activity) More calories consumed

Larger food portions and sizes Eating out more often Increases in soda, pizza, and candy consumption

Fewer calories being used up Declines in physically activity Increases in sedentary lifestyle and screen time

Computers and television time

Presenter

Presentation Notes

There are many complicated reasons for the increase. They involve… The environment: Neighborhood, school, and community design and policy Genetics: Inborn diseases, chromosomal mutations, familial traits, and ethnic predisposition Culture: Involving increased risk for minorities Social influences: Especially with respect to under-served populations Attitude: Family influence on nutrition habits and physical activity Medical advice: Doctors not taking an active role The American way of life plays a role, too! Americans are fond of larger portion sizes, eating out, an increased consumption of sugar-sweetened beverages, and computers and televisions.

8

Food Away From Home

Between 1970 and 1995 Food away from home went from 25% of

food spending to 45%

Between the late '70s and mid '90s Contribution of calories from food away-

from-home went from 18% to 34%

Away from home foods shown to be higher in fat and lower in fiber and calcium than home foods

SOURCE: USDA data, Lin et al., AG Bull 750, 1999

Presenter

Presentation Notes

The increase in eating outside of the home has played an important part in the problem. People are eating away from home more often than they did in the past. They are consuming more calories when doing so. The foods they eat outside the home are often higher in fat and lower in fiber and calcium than what they eat at home.

9

% Change in Mean Intake from 1977-78Beverages, Children 6-11 Years Old

Carbonated soda

Milk

Fruit juice

Fruit drinks

SOURCE: L. Cleveland USDA; NFCS 1977-78 and WWEIA, NHANES 2001-02, 1 day

0% % increase% decrease

-39%

54%

69%

137%

431

261 258

109

1977-78 2001-02

gra

ms

Milk Soda

Presenter

Presentation Notes

Looking at the intake of selected beverage consumption from the 1977-78 USDA food consumption survey compared to the NHANES 2001-2002 survey, we see a dramatic decline in milk intake and a dramatic and significant increase in overall intake of sweetened beverages. Milk intake in grams is only slightly higher than sodas. Other food changes over the past 25 years include: very large increases in the intake of pizza (425%) and savory grain snacks (corn chips, crackers, popcorn, pretzels) (320%). Fairly large increases in candy and grain based mixed dishes (pasta, tacos, etc) as well. Of particular concern is the drop in vegetable intake. Down 43% in 25 years. Not exactly the results one would hope to see if we were truly following the dietary guidelines. Another change has been an increase in eating outside of the home Food away from home went from 25% of food spending to 45% Between late '70s and mid '90s…Contribution of calories from food away from home went from 18% to 34% Away from home foods shown to be higher in fat and lower in fiber and calcium than home foods Milk intake is down 39% while intake of fruit juices, fruit drinks, and carbonated soft drinks are up significantly. Soda seems to be replacing milk consumption for this critical age group. The increase is due to both changes in the amount consumed and changes in the percentages of the population who consume the food. Fewer kids are drinking milk, and when they drink it ,they are drinking less.

10

% Change in Mean Intake from 1977-78Other Foods, Children 6-11 Years Old

Fried potato

Savory grain snacks

Grain mixed dishes

Pizza

SOURCE: L. Cleveland USDA; NFCS 1977-78 and WWEIA, NHANES 2001-02, 1 day

0% % increase% decrease

Candy

Vegetable -43%

320%

144%

425%

18%

180%

Presenter

Presentation Notes

Looking at changes in consumption of some other foods for this same 6-11 year old age group, this slide shows the following: Very large increases in the intake of pizza and savory grain snacks over the past 25 years. Fairly large increases in candy and grain based mixed dishes as well. A drop in vegetable intake. Not exactly the results one would hope to see if we were truly following the dietary guidelines.

11

TV Viewing, 6-11 Years, per Day

SOURCE: NHANES II, NHANES III, NHANES 1999-2000

01020304050607080

≤ 2 hours 3+ hours

Perc

ent

1988–94 1999–00 2001–02

Presenter

Presentation Notes

We all know the concerns about physical activity. Children and adults are not getting enough, and sedentary time is on the rise. Over the last three years, the amount of time spent in front of the computer screen has increased. And as more children have TVs in their bedrooms, television viewing has also increased.

12

Prevalence of Obesity by Hours of TV/Day

0

5

10

15

20

25

30

35

0 - 1 1 - 2 2 - 3 3 - 4 4 - 5 5 or more

NHES 1967-70 NLSY 1990*NHES = National Household Education Surveys**NLSY = National Longitudinal Survey of YouthFrom http://www.cdc.gov/nccdphp/burden_pres/bcd_30.htm

NHES* Youth Aged 12–17 in 1967–1970NLSY** Youth Aged 10–15 in 1990

Presenter

Presentation Notes

With an increase in television watching among youth comes another concern: we know that some data suggest an increase in obesity with the increased time spent in front of the TV. It seems to be particularly prevalent in the more recent data of the younger children. The behavioral targets included in We Can! address each of these lifestyle habits that appear to be related to the rise in childhood obesity.

13

Development of We Can! We Can! was developed based on

Recommendations from an NIH strategy development workshop

A review of science-based literature An environmental scan to review other work

on overweight and obesity Lessons learned from Hearts N’ Parks

Presenter

Presentation Notes

We Can! was developed through an extensive and thorough strategic planning process.

14

Strategy Development Workshop Convened at NIH in

February 2004 with more than 70 leading researchers, public health experts, nutritionists and dietitians, youth marketing experts, and community center representatives from around the country.

Online at www.nhlbi.nih.gov/health/prof/heart/obesity/hwcoi/

Presenter

Presentation Notes

The first part of the strategic planning process was a participatory Strategy Development Workshop held February 17-18, 2004. At the meeting, more than 70 national stakeholders helped to inform the initial program planning activities that resulted in the creation of We Can! The Workshop summary report is available online.

http://www.nhlbi.nih.gov/health/prof/heart/obesity/hwcoi/�

http://www.nhlbi.nih.gov/health/prof/heart/obesity/hwcoi/�

15

Review of Science-Based Literature Review of latest science, including

Peer reviewed journals to select target audience, behavioral objectives, and intervention settings

NIH 2004 workshops on obesity prevention

2004 Institute of Medicine Report (IOM) Preventing Childhood Obesity: Health in the Balance

Final review by IOM panel members and other leading scientists

Presenter

Presentation Notes

Another component was a thorough review of science-based literature.

16

Environmental Scan A review of more than 50

Federal and non-Federal programs addressing overweight and obesity at the national level

Captures project descriptions, objectives, partners, target audiences, topics, locations, and components per program

Also tracks Federal planning initiatives (e.g., NIH Obesity Research Task Force) and non-Federal initiatives (e.g., IOM Committee on Prevention of Obesity in Children and Youth)

Confirms need for emphasis on parents

Provides valuable list of potential We Can!partnerships for collaboration to reach youth, physicians, and other key audiences

Presenter

Presentation Notes

The third component was an environmental scan, or review, of national programs that addressed overweight and obesity. This activity confirmed a need to emphasize the important role of parents in addressing the problem. By reviewing more than 50 existing national programs and initiatives, it became clear where potential partnerships might be created. These collaborations are key in reaching youth, physicians and other important audiences.

17

Lessons Learned From 50 Magnet Centers in 11

States Annual increases in the number

of programs implemented Annual increases in the number

of youth and adults reached Changes in participant

knowledge, attitudes, and behavioral intent

Magnet Center feedback Positive experience Need for increased focus on

parents and families Need to provide better linkages

between physicians and community resources

Evaluation component highly valued

Demonstrates existing community-based capacity to address overweight and obesity

Shows need to target parents/primary caregivers

Provides helpful feedback for materials development, channels and possible messages

Presenter

Presentation Notes

Finally, through Hearts N’ Parks, a three-year collaboration between the National Institutes of Health’s (NIH) National Heart, Lung, and Blood Institute and the National Recreation and Park Association, some important lessons were learned. Among them: First, a demonstrated capacity exists at the community level to address overweight and obesity. Second, programs need to target parents and primary caregivers. This and other information from Hearts N’ Parks also helped inform the strategic planning process for We Can!

18

We Can! Program Description

Target Audiences: Parents and Youth Behavioral Objectives Intervention Settings

Presenter

Presentation Notes

As a result of this process, We Can! was created. We Can! provides activities and programs that encourage improved nutritional choices, increased physical activity, and reduced screen time in youth ages 8-13. We Can! is unique among existing youth obesity-prevention initiatives in its focus on programs and activities for parents and families as a primary group for influencing youth audiences. We Can! has two target audiences: parents and youth. Through We Can!, we deliver programs, host community events and promote media messages that encourage specific behavioral objectives in both youth and adults. These behavioral objectives are encouraged in both home and community settings.

19

Parents/Primary Caregivers Studies show parents as effective change

agents concerning obesity. The home is a primary source of nutrition for

children. Parents can act as effective role models for

youth. Parents are asking for resources. Relatively few programs are targeting families

and the home environment.

Presenter

Presentation Notes

Parents are a critical target audience for We Can! They can influence what children eat at home and act as effective role models for their children. Parents are hungry for resources, tips, and help. And, with relatively few programs that target parents and the home environment, there is a void that We Can! can fill.

20

Youth Ages 8-13 National survey data show 17% of children

and youth as overweight. A high likelihood of obesity transfer from

adolescence into adulthood. Health consequences associated with obesity.

Heart disease Asthma High blood pressure Type 2 diabetes Many more!

Public health environment looks amenable to change concerning youth audiences.

Presenter

Presentation Notes

Youth ages 8-13 were chosen as a second target audience. In addition to data showing that 16% of children and youth are overweight, there is a high likelihood of obesity transfer from adolescence into adulthood. And health consequences associated with obesity are increasingly being seen in children.

21

Behavioral ObjectivesYouth Ages 8–13

Choose a sufficient amount of a variety of fruits and vegetables per day.

Limit intake of high-fat foods and energy-dense foods that are low in nutrients.

Control portion sizes of foods consumed.

Substitute water, fat-free milk, or low-fat milk for sweetened beverages.

Engage in at least 60 minutes of moderate physical activity on most, preferably all, days of the week.

Reduce sedentary activity by limiting screen time to no more than 2 hours per day.

Parents/Primary Caregivers

Increase the availability and accessibility of healthy foods in the home.

Limit the availability and accessibility of sweetened beverages and high-fat, high-density/low-nutrient-value foods in the home.

Control portion sizes of foods consumed.

Support and enable family physical activity.

Support and enable reduced screen time.

Presenter

Presentation Notes

We Can! focuses on six behavioral objectives for youth ages 8-13 and five for parents and primary caregivers of youth ages 8 to 13. [Read objectives]

22

Intervention SettingsHome

“A child’s health and well-being is fostered by a home environment with

engaged and skillful parenting that models, values, and encourages

sensible eating habits and a physically active lifestyle.”

– IOM 2004

Community“Local governments, public health agencies, schools, and community

organizations should collaboratively develop and promote programs that

encourage healthful eating behaviors and regular physical activity,

particularly for populations at high risk of childhood obesity.”

– IOM 2004

– IOM 2004

Presenter

Presentation Notes

We Can! reaches parents and caregivers in home and community settings with educational materials and activities to encourage healthy eating, increase physical activity and reduce sedentary time. This distinguishes us from school-based and youth-focused programs on this topic.

23

We Can! Program Elements

Community Outreach Media and Consumer Outreach Program Resources and Channels Partnership Outreach

Presenter

Presentation Notes

So how will this happen? We Can! has four central program elements: Community Outreach; Media and Consumer Outreach; Program Resources and Channels; and Partnership Outreach.

24

Community Outreach

Presenter

Presentation Notes

Community Outreach.

25

Community Outreach More than 1,170 communities across the

country and around the world have signed up for We Can!.

In coordination with these efforts, we are implementing Programs with youth ages 8 to 13 Programs with parents of youth ages 8 to 13 Community events

Presenter

Presentation Notes

There are over 1,000 communities around the country implementing We Can! programming in a diversity of rural, urban, and suburban settings. The programs we are implementing are designed for youth ages 8-13 and for parents of youth ages 8-13. We are also holding community events. [Describe your local plans.]

26

Look who We Can is reaching out to! Clinicians Educators Parks and recreation department staff County extension agents Dieticians Coaches Occupational health professionals Public health professionals

27

Community Site Update

A total of 1,172 Community Sites have signed up for We Can! in all 50 states, the District of Columbia, Puerto Rico, the Northern Mariana Islands, the Virgin Islands, and 11 other countries (Antigua and Barbuda, Australia, Bangladesh, Canada, Fiji, Greece, India, Israel, Nigeria, the Philippines, and Uganda).

Demonstrating program flexibility, adaptability and value, Sites represent a diversity of implementation settings, from schools and park and recreation departments to hospitals, health systems and public health departments (12 different settings in total).

28

116 Intensive Community SitesState City Description

AL Birmingham Health Education Linkage Programs (Project HELP) USA

AL Birmingham Bethel Community Learning Center

AL** Statewide Statewide coalition led by the State Department of Health in partnership with the Department of Education

AZ Cottonwood Cardiac Care

AZ Glendale Child Obesity Center

AZ Nogales University of Arizona COOP Extension

CA Los Angeles Drive Kids to Be Fit

CA Norco Alvord United School Distirct

CA Northridge North Valley YMCA

CA San Diego Ellen Browning Scripps Elementary School

CA South Lake Tahoe Parks and Recreation

CA Whiteriver White Mountain Apache Health Education

CO Centennial Integrated Health Center

CO Greeley Sunrise Community Health Center

CO Thornton Explore Elementary School

CT Stamford Stamford Hospital

DC Washington Chartered Health Plan

DC Washington Corder Pounders Fitness and Nutrition

FL Fort Lauderdale Vital For Life, Inc.

**A Founding We Can! Intensive Community Site

Presenter

Presentation Notes

The Intensive Community sites. State, city/town and site description/name. There are 14 Founding Intensive Sites; the asterisk indicates a non-founding site.

29

116 Intensive Community Sites (cont.)State City Description

FL Indialantic MIMA

FL Jacksonville Nemours Children’s Clinic

FL Miami Dr. Rafael A. Penalver Clinic, INC.

FL Saint Cloud Innovative Behavioral Services

FL** Tamarac City of Tamarac Parks and Recreation

GA** Athens Athens-Clarke County Leisure Services

GA Atlanta CHAPM

GA Augusta Neighborhood Improvement Project

GA Baxley Appling Healthcare

GA Macon Bibb County School District

GA Norcross Victory Community Sports Foundation

GA Smyrna Imagine International Academy of Smyrna

GA Smyrna & Kennesaw We Can! in Cobb/Cobb & Douglas Public Health & Cobb County School District

HI Honolulu Kokua Kalihi Valley

IL Chicago Malcolm X College

IN Columbus Healthy Communities Initiative

IN East Chicago Multicultural Wellness Network

IN Fort Wayne Parkview Hospital

IN Indianapolis Clarion Health

IN Michigan City Temple Total Fitness


30

116 Intensive Community Sites (cont.)State City Description

KS Kansas City University of Kansas Medical Center, Department of Pediatrics

KS Manhattan Riley County Manhattan Health Department

KS Newton Newton Seventh Day Adventist Church

KY Bowling Green Barren River District Health Department

KY Burlington YMCA – RC Durr

KY Danville Families First, FRC

KY Georgetown Western-Anne Mason Family Resource Center

KY Providence The Rosenwald Center Corporation

LA Minden All Age Medical P.C., Inc.

MA Fitchburg BF Brown Middle School

MA North Dartmouth Medical Survival Consultants

MA** Pittsfield Hillcrest Campus of Berkshire Medical Center

MA Roxbury Sociedad Latina

MD Columbia Liberty Seventh Day Adventist Church

MD La Plata Civista Health and Charles County Health Department

MD** Montgomery County Montgomery County Recreation Department

MD Waldorf ABC Wellness and Fitness Center

ME Kennebunk Jump Ropin’ Rays

MI** Ann Arbor Project Healthy Schools: A Community-University Collaborative

MI Clinton Township St. Joseph’s Medical Center School Health Network

MI Detroit Detroit Department of Health and Wellness Promotion


Presenter

Presentation Notes

The Intensive Community sites. State, city/town and site description/name.

31

116 Intensive Community Sites (cont.)**A Founding We Can! Intensive Community Site

State City Description

MI Flint The Good Samaritan Family Network

MI Muskegon Muskegon County Health Department

MI Pontiac The Baldwin Center

MI Rochester Hills Nutrition Emphasis Center

MO Fulton Callaway County YMCA

MN Minneapolis Fremont Community Health Services

MS Jackson North Jackson Baptist Church

MS Tunica Tunica County

MO Columbia University of Missouri-Columbia Sinclair School of Nursing

MO Sedalia Weight Watchers

MO** Springfield Springfield-Green County Park Board

MP Tinian Tinian Elementary School

NC Durham Families In It Together (FIIT)

NC Kings Mountain Ervin Clinic

NJ Irvington Sivian Nutrition and Health Consulting, LLC

NV** Henderson University of Nevada Las Vegas Department of Nutrition Sciences

NV Las Vegas Clear Beverage Corporation

NY Corona Public School 19

32



NY Clayton The River Rocks Cancer Support Group

NY Penfield Penfield Pediatrics

NY Poughkeepsie Nubian Directions, Inc.

OH Akron Akron Children’s Hospital

OH Cincinnati Nutrition Council

OH Cleveland A Touch of Sugar Healthy Lifestyle Center

OK Ada Ada Public Schools

OR** Lane County Lane Coalition for Healthy Active Youth

OR McMinnville Linfield College/Kid Fit

OR Portland Familiias en Accion

PA Brockway After School at Moorhead

PA Guys Mills Crawford County Kids

PA Mercer Cool Springs Fitness & Aquatics

PA Pittsburgh Children’s Museum of Pittsburgh

RI Central Falls Channel One-Central Falls/Ralph J. Holden Community Center

RI Providence Rhode Island Department of Health, Initiative for Healthy Weight

RI Woonsocket Thundermist Health Center of Woonsocket

SC Clemson Clemson University – College of HEHD

33



SC Columbia The Vision Foundation

SC Darlington Pee Dee Minority Health Inc.

TN Clarksville Academy for Academic Excellence

TN Memphis New Beginning Ministries Church

TN Sneedville ETSU School-Based Health Centers

TX Austin South Family YMCA of Austin

TX El Paso Youth Obesity Prevention

TX Nacogdoches Nfusion YouthSports & Fitness Inc.

TX** Temple The Children’s Hospital at Scott & White

WI Janesville Mercy Health System

WY Cheyenne Wyoming Department of Health

Canada Orangeville, Ontario

Dufferin Area Family Health Team

Fiji Suva No organization

34

16 We Can! Cities and CountiesState City Description

GA Brunswick CIA Sportsclub

GA** Roswell Roswell Recreation and Parks Department

GA Savannah Coastal Health District

IN** Gary Gary Youth Services Bureau and Park Recreation

IN** South Bend South Bend Parks and Recreation Department

MA** Boston Boston Public Health Commission

MI Berrien County Lakeland Regional Health System

NV Carson City Washoe Tribe

NV Las Vegas University of Nevada Las Vegas Department of Nutrition Sciences

NY Binghamton Creative Nutrition Solutions

NY Broome County Steps to a Healthier NY

PA Indiana Indiana Medical Center

PA Pittsburgh UPMC Health Plan

PA Armstrong Armstrong County Commissioner

PR Caguas Corporacion S.A.N.O.S.

TN Knox County Knoxville Area Coalition on Childhood Obesity


35

1039 General Community SitesAL Brewton, Camden, Mobile (2 sites), Montgomery (2 sites), Opelika, Tarrant, Union Springs (2 sites)

AK Anchorage, Bethel, Sitka, St. Paul Island, Unalaska

AZ Goodyear, Mesa (2 sites), Nogales, Peoria, Phoenix (2 sites), Queens Creek, Tempe, Tucson (4 sites)

AR Little Rock (3 sites), Marshall (2 sites)

CA Anaheim, Chico, Colton, Concord, Costa Mesa, Diamond Bar, Downieville, Fremont, Fort Bragg, Fountain Valley, Fullerton, Goleta, Imperial Beach, Indio, La Jolla, Lancaster, Long Beach, Los Angeles (4 sites), Manteca, Marina del Rey, Modesto, Newark, North Hollywood, Oakland, Ontario, Orange, Orangevale, Oroville, Oxnard, Pine Valley (2 sites), Red Bluff, Redwood City, Sacramento (2 sites), San Bernardino, San Diego (9 sites), San Fernando, San Francisco (2 sites), San Jose (4 sites), San Leandro, San Marcos (2 sites), Santa Ana, Santa Barbara, Santa Clarita, Santa Fe Springs, Santa Paula, Santee (2 sites), Stockton, Sunland, Truckee, Ukiah, Upland, Vacaville, Ventura, Visalia, Vista, Walnut Creek, Weed, West Sacramento, South Lake Tahoe, Yuba City (2 cities)

CO Alamosa, Arvada, Aurora, Denver (2 sites), Golden, Larkspur, Towaoc

CT East Lyme, Enfield, Middletown, New Britain, New London, New Milford, Norwalk, Norwich, Uncasville, Wethersfield

DE Fenwick Island, Greenville, Seaford

DC Washington, DC (12 sites)

FL Apopka, Bristol, Chiefland, Deltona, Fort Myers, Fort Pierce, Ft. Walton Beach, Gainesville, Hollywood (3 sites), Hialeah, Homestead, Homosassa (2 sites), Immokalee, Indiantown, Jacksonville (4 sites), Largo, Lauderhill, Leesburg, Miami (4 sites), Miami Beach (2 sites), North Miami, North Miami Beach, Ocala (2 sites), Oldsmar, Okeechobee, Orlando (2 sites), Palm Beach Gardens, Palm City, Perry, Port St. John, Port St. Lucie, St. Marks, St. Petersburg, Sarasota (2 sites), Sebastian, Starke, Stuart (2 sites), Tallahassee (3 sites), Tampa (2 sites), Titusville (2 sites), Vero Beach

GA Acworth, Albany (2 sites), Atlanta (4 sites), Augusta, Austell, Brunswick, Calhoun, Carrollton, Clarkesville, Columbus, Dahlonega, Decatur (2 sites), Ft. Stewart, Gainesville (3 sites), Greensboro, Jackson, Kennesaw, LaGrange, Lawrenceville, Lithonia, Macon (2 sites), Marietta (2 sites), McDonough, Powder Springs, Rome, Savannah(2 sites), Smyrna, St. Marys, St. Simon’s Island, Stone Mountain

HI Waimanalo

ID Boise (2 sites), Council, Fort Dodge, St. Anthony (2 sites)

IL Addison, Algonquin, Aurora, Bourbonnais, Cahokia, Charleston (2 sites), Chicago (12 sites), Decatur, Ford Heights, Glenview, Homewood (2 sites), Murray, Northlake, Oak Lawn, Oak Park (2 sites), Oglesby, Olympia Fields, Oquawka, Peoria, Peru, Pinckneyville, Rockford, Shorewood, Spring Valley, Sterling, Urbana

IN Anderson, Clinton, Covington, Crown Point, Dyer, Elkhart (2 sites), Evansville, Fort Wayne (2 sites), Goshen, Greensburg, Huntington, Indianapolis (5 sites), Lafayette, Michigan City, Mishawaka, Monroeville, Muncie, Plymouth, Poland, Portage (2 sites), Muncie, South Bend, Terre Haute, Trafalgar (2 sites), Valparaiso

(3 sites), West Lafayette

Presenter

Presentation Notes

The General Community sites. State and site location.

36

1039 General Community Sites (cont.)

l

IA Anamosa, Ankeny, Burlington, Des Moines, DeWitt, Fort Dodge, Huxley, Mt. Pleasant, Sioux City

KS Council Grove (2 sites), Ellsworth, Emporia, Kansas City (2 sites), Lawrence, Mayetta, Meade, Pittsburgh, Prairie Village, Wichita (4 sites), Winfield

KY Alexandria, Bardstown, Benton (3 sites), Berea, Betsy Lane, Bowling Green (2 sites), Brooksville, Burgin, Burkesville (2 sites), Campbellsville, Clinton (2 sites), Cold Spring, Corbin, Cynthiana, Danville, Glasgow, East Bernstadt, Eddyville (2 sites), Elizabethtown, Elkhorn City, Felmingsburg, Frankfort, Georgetown (2 sites), Greenville, Grays Knob, Henderson, Highland Heights, Hodgenvile, Hoskinston, Jamestown, LaCenter, LaGrange, Lebanon (2 sites), Leitchfield (2 sites), Lexington (2 sites), Louisa (2 sites), Louisville (11 sites), Lucas, Manchester, Marion, Mayfield (6 sites), Mt. Sterling, Munfordville, Mt. Washington, Owensboro, Owingsville, Pikeville, Pineville, Richmond, Salem, Shepherdsville, Somerset, Stamping Ground, Stanton, Tompkinsville, Versailles, Warsaw, Williamsburg, Williamstown

LA Anacoco, Baldwin, Baton Rouge (2 sites), Farmerville, Franklin, Independence, Mandeville, Morganza, Natchitoches, Ruston, Shreveport

ME Bowdoin, Kennebunk, Parsonsfield (2 sites), Saco, Skowhegan, Waterville

MD Annapolis, Baltimore (6 sites), Bowie, Cambridge, Centreville, Clarksburg, Clinton (2 sites), College Park, Columbia, Frederick, Glen Burnie, Howard County, Hughesville, Hyattsville, Kensington, Lee’s Summit, Montgomery Village, Nottingham, Oakland, Pasadena, Queen Anne’s County, Westminster

MA Acton, Boston (2 sites), Chelsea, Dorchester, Fall River, New Bedford, Longmeadow, Palmer, Quincy, Roxbury (2 sites), South Boston, Wellfleet, Wellesley, Worcestor (2 sites)

MI Ann Arbor, Atlanta, Au Train, Burton, Cadillac, Chesterfield, Clinton Township, Detroit (5 sites), Grand Rapids, Holland, Lansing (2 sites), Lapeer, Lincoln, Manistique, Marquette, Mt. Pleasant, Pittsford, Rochester, St. Joseph, Sturgis, Warren

MN Baxer, Brooklyn Center, Grand Marais, Mankato, Minneapolis (3 sites), Moorehead, Slayton

MS Batesville, Jakson, McLain, Port Gibson (2 sites), Rolling Fork, Terry, Tupelo, Yazoo City

MO Bolivar, Buffalo, Columbia, Joplin, Kansas City (4 sites), Kirksville, Mountain Grove, Nevada, New London, Poplar Bluff, Rolla, Slayton, St. Joseph (2 sites), St. Louis, St. Peters, Van Buren (2 sites), Warsaw

MT Ashland, Big Timber, Billings, Great Falls (3 sites), Havre, Livingston, Missoula

NE Columbus (2 sites), Lincoln, Omaha (4 sites), Scottsbluff, Sidney

NV Carson City (4 sites), Gardnerville, Henderson, Las Vegas (3 sites), Reno (2 sites), Silver Spring

NH Barrington, Bedford (2 sites), Berlin, Kingstown, Littleton, Stratham

NJ Belvidere, Bridgeton, Bridgewater, Butler, Camden, Edison, Egg Harbor, Englewood, Flemington, Fords, Glen Rock, Hackettstown, Highlands, Jersey City, Lakewood, Long Branch, Maplewood, May’s Landing, Neptune, Newark (2 sites), Oceanville, Paterson (2 sites), Princeton, Spotswood, St. Davids, Toms River (2 sites), Union, Vauxhall

Presenter

Presentation Notes

The General Community sites. State and site location.

37

1039 General Community Sites (cont.)NM Albuquerque (4 sties), Dulce, Las Cruces, Pine Hill, Silver City

NY Albany, Beacon, Brooklyn (5 sites), Bronx (7 sites), Broome County, Carle Place, Cortland, Elmhurst, far Rockaway, Forest Hills, Glens Falls, Hastings, Hawthorne, Katonah, Kerhonkson, Latham, Lake Placid, Malone, New Windsor, New York (9 sites), Port Chester, Rochester (2 sites), Rockville Centre, Rome,

Saranac Lake, Saratoga Springs, Spring Valley, Staten Island (5 sites), Syracuse (2 sites), Westfield, Wheatley Heights

NC Asheville (2 sites), Ayden, Badin, Bryson City, Burlington, Charlotte, Concord, Dunn, Elizabeth City, Faison, Goldsboro, Graham, Greenville (4 sites), Hendersonville, High Point (2 sites), Linden, Raleigh, Ramseur, Rocky Mount, Wilmington, Winton

ND Fargo (3 sites), Beulah (2 sites)

OH Akron, Auburn Township, Bay Village, Bowling Green (2 sites), Cambridge, Canfield, Chillicothe, Cincinnati, Cleveland (5 sites), Cleveland Height, Columbiana, Columbus (3 sites), Dayton, Defiance, Elyria, Fremont, Grove City, Hamilton, Hillsboro (2 sites), Lancaster (2 sites), Lima (2 sites),Mantua, Napoleon, Ottawa, Painesville (2 sites), Parma, Steubenville, Toledo (2 sites), Toronto, Troy, Wheelersburg

OK Concho, McAlester, Moffett, Oklahoma City (2 sites), Red Rock, Tulsa, Tahlequah, Wagoner

OR Ashland, Benton County**, Burns, Bend, Keizer, Portland, Tualatin

PA Allentown, Berwick, Bethlehem (2 sites), Bradford, Brookville, Camp Hill, Clarion, Coatesville, Danville, Delta, Dickson City, Downington, DuBois, Easton,Elizabethtown, Emmaus, Erie, Exton, Franklin (2 sites), Greenville, Hanover (3 sites), Harrisburg (2 sites), Hazleton, Hershey, Honesdale, Indiana, Johnstown (3 sites), King of Prussia, Kittanning, Lancaster (2 sites), Langhorne (2 sites), Malvern, Muncy, Norristown, Philadelphia (8 sites), Pittsburgh (2 sites), Robesonia, Russellton, Sewickley, Sigel, Uniontown, Upland, Upper Darby, Wellsboro, West Middlesex, West Mifflin, Wilkes-Barre

RI Cranston

SC Anderson (2 sites), Columbia (4 sites), Fort Mill, Kingston, Lancaster, McClellanville, Moncks Corner, Sheldon, Swansea, Winnsboro (2 sites)

SD Chamberlain, Ft. Thompson (2 sites), Pierre, Pine Ridge, Sioux Falls

TN Chattanooga, Decatur, Johnson City (2 sites), Jonesborough, Kingsport, Knoxville (2 sites), La Vergne, Lexington, Madisonville, Memphis (2 sites), Nashville (2 sites), Newport, Oak Ridge, Rogersville, Seymour, Sneedville, Springfield

TX Abilene, Baytown, Carrollton, Corpus Christi, Cotulla, Denison, Denton, El Paso, Fort Arthur, Fort Worth, Houston, Humble, Irving, Knoxville, Lubbock, Mcallen, Mesquite, Odessa, Park, Paris, Pasadena (2 sites), Randolph AFB, Round Rock, San Antonio, Tyler, Waco

UT Cedar City, Salt Lake City (2 sites), South Jordan

VA Alexandria, Arlington, Arlington County, Chesapeake, Fairfax, Falls Church, Farmville, Hampton, Harrisonburg (2 sites), Herndon, Lynchburg, Milford, Narrows, Newport News, Norfolk (4 sites), Portsmouth, Richlands, Richmond (4 sites), Roanoke (2 sites), Virginia Beach. Warrenton, Woodbridge


38

1039 General Community Sites (cont.)VT Barton, Burlington, Montpelier, Whitingham

WA Chelan, Lynnwood, Moses Lake, Oak Harbor, Poulsbo, Pullman, Renton, Seattle, Union Gap

WV Beckley, Birch River, Bluefield, Cairo, Charleston (2 sites), Charles Town, Fairmont (3 sites), Fort Ashby, Franklin, French Creek, Harpers Ferry, Huntington, Hurricane, Madison, Martinsburg (2 sites), Mill Creek, Moorefield (2 sites), Morgantown, Mount Storm, Princeton (2 sites), Ravenswood, Reader, Romney, Shepherdstown, Sistersville (2 sites), Sophia, Summersville (3 sites), Union, Williamsburg

WI Brookfield, Fort Atkinson, Green Bay (2 sites), Madison, Manitowoc, Milwaukee (12 sites), Monroe, Rice Lake

WY Casper

Abroad St. Paul’s, Antigua and Barbuda, Queensland, Australia; Ontario and Alberta, Canada; Athens, Greece; Karamsad, India; Ilorin, Nigeria; Saipan and Tinian, Northern Mariana Islands (2 sites); Baguio City and Manila, Philippines; Barceloneta, Bayamon, and San Juan, Puerto Rico (2

sites); Cidra, Puerto Rico; St. Thomas, Virgin Islands; Kampala, Uganda


39

Program Resources and Channels

Presenter

Presentation Notes

Program Resources and Channels.

40

We Can! Resources

1-866-35-WECANhttp://wecan.nhlbi.nih.gov

41

We Can! Materials

We Can! Energize Our Community: Toolkit for Action Parent curriculum Community events

Presenter

Presentation Notes

The We Can! Toolkit for Action includes a variety of tools and resources, including curricula for community adult and youth programs.

42

Youth Curricula•Kids Club – After-school, summer day care setting for children (K-5) contains three elements– curriculum, and PA and snack components.

• SMART- Student Media Awareness to Reduce Television –3 or 4th grade classroom curriculum designed to reduce TV and video game usage.

•Eat, Think and Be Active – 10 lessons helping children (11-13) understand the connections between media and health.

Presenter

Presentation Notes

Three youth curricula are being offered to the communities as either after-school or school based programs that they can provide to the children. Two of the three curricula, CATCH and Smart are two good examples of taking research based interventions and putting them to use in the community. CATCH Kids Club, based on the successful in-school program, is a physical activity and nutrition education program for elementary school-aged children (grades K–5) in afterschool and summer care settings. Both the original school-based CATCH and CATCH Kids Club use a coordinated approach to helping children adopt healthy dietary and physical activity behaviors by positively changing the health environments of recreation programs, schools and homes. The CATCH Kids Club consists of three programmatic elements: a curriculum component, a physical activity component, and a snack component. The field-tested materials include a CATCH Kids Club Activity Box, which contains activities for afterschool and community-based programs, and a binder with nutrition activities and snack recipes. Student Media Awareness to Reduce Television (S.M.A.R.T.) is a 3rd or 4th grade classroom curriculum designed to motivate children to reduce their television watching and video game usage. Studies conducted by Stanford University researchers have shown that reducing time spent watching television and playing video games can result in lower prevalence of childhood obesity as well as less aggression in children. The S.M.A.R.T. curriculum was successfully tested with elementary schools in the San Francisco Bay Area. The curriculum is intended to be used over the course of the school year and includes all the lesson plans and tools needed to implement the program. Media-Smart Youth: Eat, Think, and Be Active! is a 10-lesson curriculum funded by the National Institute for Child Health and Human Development (NICHD) that focuses on helping young people ages 11 to 13 understand the connections between media and health. The program uses nutrition and physical activity examples to help youth learn about these connections and build their media analysis skills. Media-Smart Youth brings together a mix of learning formats, including brainstorming, small- and large-group discussions, games, and creative productions. All these activities are intended to create discussion and encourage problem solving and critical thinking. The curriculum includes 10 structured lessons with activities that explore media, nutrition, or physical activity topics. Each lesson also includes a Snack Break and an Action Break. These breaks reflect the nutrition and physical activity content of the curriculum and provide a fun, hands-on way to experience these concepts. The curriculum concludes with a Big Production—an opportunity for participants to use what they have learned to create a media project designed to motivate other young people to take action for better nutrition or increased physical activity. In the process, the youth learn new skills in production, teamwork, and creativity. (add period)

43

We Can! Materials We Can! Families

Finding the Balance: A Parent Handbook English Spanish

Presenter

Presentation Notes

The We Can! Parent Handbook has been focus-group tested with adults in three cities. It provides parents and caregivers with information and practical tips on how to offer healthier food and beverage choices and how to increase physical activity and decrease screen (TV or computer) time. The parents who reviewed the Handbook felt that it was very useful and helpful and indicated that the tips it offered were things they could try and implement right away. They also felt the content would help them keep increased physical activity and good nutrition top-of-mind. The Handbook is available in English and Spanish.

44

Media and Consumer Outreach

Presenter

Presentation Notes

Media and Consumer Outreach.

45

Media and Consumer Outreach National and Local Media

Public service announcements (print and radio) Media kits (press releases, media advisories) Launch announcements Matte articles Press releases for program milestones

National Consumer Outreach Consumer Web site

Media Partners

Presenter

Presentation Notes

We have three We Can! core media messages: We Can! is a national public education program from NIH to help prevent overweight and obesity among youth ages 8-13. We Can! reaches parents and caregivers in home and community settings with educational materials and activities to encourage healthy eating, increase physical activity, and reduce sedentary time. We Can! is based on an in-depth review of the leading science-based literature on obesity prevention, an environmental scan of relevant materials from other Federal and non-Federal agency programs, as well as the demonstrated capacity of community-based settings such as those involved in NHLBI’s Hearts N’ Parks program. Media outreach will take place at both the national and local level. We will use a variety of tools to reach out to local media about our program. National media will direct parents and caregivers to tips and information on the We Can! Web site. We Can! representatives are having partnership discussions with national media in representing print, radio, online, and television outlets. These outlets include: Parenting magazine, the National Cable Television Association, Black Entertainment Television (BET), Univision (Spanish language), and others.

46

We Can! on the Web

Become a friend of We Can! on MySpace

(http://www.myspace.com/nihwecan) View “We Can! and You Can Too” and

animations on YouTube Connect on LinkedIn(http://www.linkedin.com/in/nihwecan)

47

Partnership Outreach

Presenter

Presentation Notes

Partnership Outreach.

48

Over 20 National Partners! Over 20 National Partners & Supporting Organizations

have joined We Can!

Continually in ongoing discussion with additional partners

Federal Partners Clinical Partners

Outreach Partners Media Partners

Corporate Partners

49

We Can! Partnerships

The We Can! partnership goal is to work collaboratively with others to build synergy on preventive strategies and an array of outreach efforts.

Through partnerships, we can most effectively leverage resources and channels to disseminate We Can! messages and materials to parents, caregivers, and youth ages 8–13.

Presenter

Presentation Notes

On a local level, we are working to build partnerships with groups like yours to build synergies and strengthen our outreach activities. Partnerships are a crucial tool for us to meet our goal of building awareness of and action around youth-related obesity prevention. They are essential in reaching as many parents, caregivers and youth as possible.

50

Levels of Partner Commitment Organizations invited to participate as

Partners or Supporting Organizations Partners

Participate on a variety of fronts with a significant commitment of resources and activity

Supporting Organizations Groups that are interested but unable to make

as significant commitment

Presenter

Presentation Notes

There are two levels of We Can! partner commitment: Partners and Supporting Organizations. Our organization is participating at the ______________ level.

51

We Can! National Partners National partners coming on board to support

We Can! and participate on a variety of fronts Provide resources:

Support of program activities and materials development (printing, distribution, event sponsorship, etc.)

Contacts and support to We Can! sites

Disseminate We Can! messages via organizational communication channels (Web sites/Web links, newsletters, listservs, direct mailings to constituents)

Presenter

Presentation Notes

We Can! has and continues to secure partnerships with a variety of organizations such as ours. These groups will provide resources and help spread We Can! messages to the widest audience possible. These are some samples of possible activity.

52

We Can! National Partners (cont.) Offer exhibit space to We Can! at

national/regional conferences and events Offer opportunities to present at meetings Offer to help recruit We Can! Community Sites Offer other support/activities specific to the

partner’s own interests and capacity

Presenter

Presentation Notes

Additional potential activities. Each partner will support activities that are specific to that organization’s interests and capacity/resources. We are supporting We Can! via _______________________ [INSERT SAMPLE ACTIVITIES].

53

Benefits of Participation Opportunity to be part of trans-NIH

national program Opportunity for extended outreach

channels and additional synergy through We Can! communication channels

Be recognized in We Can! materials Receive We Can! Partnership Toolkit

Presenter

Presentation Notes

These are but a few examples of the benefits of participating in We Can!

54

We Can! Resources for Partners Comprehensive Partner Toolkit Offers overview, tools, and template

materials News releases, template article, message

points, print PSAs (English/Spanish), radio PSA scripts (English/Spanish), sample materials, template PowerPoint presentation, sources of statistics, logos, and more in printed and electronic (CD-ROM) versions

Presenter

Presentation Notes

All We Can! Partners and Supporting Organizations receive a comprehensive Partner Toolkit with information and tools; these tools will help us participate in and promote our involvement with We Can!

55

Partnerships The role of each We Can! partner will vary

because every collaboration will be designed/crafted to channel the partner’s natural strengths, networks, and influence at the community level.

Involvement by individual groups will depend on any existing programs the partner might already have in place, the resources the partner can contribute, and the partner’s own infrastructure and reach — We Can! wants relationships to be win-win situations!

Presenter

Presentation Notes

Each partnership, including ours, is designed around the Partner’s or Supporting Organization’s network, strengths, and constituency. Groups that already have existing programs are encouraged to incorporate We Can! messages into outreach activities, though having an existing program already in place is certainly not a requirement of participation in We Can! The program will work within any resources the partner may be able to contribute and within the organization’s infrastructure and reach.

56

Examples of How We Hope You’ll Help

Participate in planning and provide resources/support activities

Disseminate messages and materials to constituencies through existing communication channels (direct mailings, newsletters, flyers, online, etc.)

Support/participate in and help drum up interest in/awareness of any local events

Presenter

Presentation Notes

There are many ways in which we can get involved with We Can! Those on this slide represent only a few. Participate in program and event planning as well as offer resources Help disseminate We Can! messages and materials to our membership and/or constituents through any existing channels already in place Support and participate in local events at community sites and help increase interest in and awareness of them.

57

Local Partners Include…

Business: grocers, printers, sporting-goods stores, T-shirt vendors, transportation providers

Civic/Community: chambers of commerce; local health, youth-related, and other coalitions

Health Care: health care providers, including hospitals and clinics; insurers

Government: local, county, State Media: cable, newspapers, radio, television Multicultural and Faith-Based Organizations Professional Organizations: dietitians, nurses,

physicians

Presenter

Presentation Notes

At the local level, We Can! Intensive Communities are working to build community partnerships with a variety of organizations. These potential partners fall into the areas of business, civic/community, health, government, media, multicultural, professional organizations, and other areas. Some local sites are collaborating with the state, regional, or local chapters of national organizations.

58

A Few Potential Benefits: Local Partners Opportunity to be part of the NIH national We Can!

program and programming at the local level

Opportunity to bring relevant resources and core health and related messages together under the We Can! umbrella

Opportunity for partners to extend their own outreach channels and create additional synergy for themselves

Opportunity for recognition as part of this exciting effort; opportunity for promotion of your existing activities/programming

Presenter

Presentation Notes

There are many potential benefits to partnering with We Can! Those benefits include: The opportunity to be a part, at the local level, of a national NIH program. The opportunity to bring our resources and programmatic messages under the We Can! initiative’s umbrella. The opportunity for us to extend our outreach through the power and reach of We Can! The opportunity to gain recognition as a part of We Can! and to promote our existing activities and programs.

59

With Your Help…

Succeed!

Presenter

Presentation Notes

With your help, We can! succeed!

60

Potential Partnership Ideas and Collaborations

Open Discussion

Presenter

Presentation Notes

Now I’d like to hear from you. First of all, are there any questions? [Answer questions.] I presented a few partner ideas and collaborations. Knowing what you now know about We Can!, how might your organization be able to help with this important initiative? [Open discussion]

61

Thank You!

Presenter

Presentation Notes

Now I’d like to hear from you. First of all, are there any questions? [Answer questions.] I presented a few partner ideas and collaborations. Knowing what you now know about We Can!, how might your organization be able to help with this important initiative? [Open discussion]

Documents

A National Obesity-Prevention Program Developed …...Source: National Center for Health Statistics Among children and teens ages 6-19, 17.1 percent are overweight according to the